Telephonic Nurse Case Manager

Rising Medical Solutions

About The Position

As a Telephonic Nurse Case Manager, you will coordinate all aspects of care for high-risk individuals. You will evaluate patients, direct treatment plans, discuss claims, benefits, and eligibility, and manage resources in collaboration with patients, families, and other medical professionals. The role promotes quality, cost-effective care and supports injured or disabled individuals in returning to an optimal level of work and functioning.

Requirements

RN license; a license in a compact state is preferred.
Strong computer skills, including Microsoft Outlook, Excel, and Word.
Experience with Workers’ Compensation or Disability Management.
Ability to maintain confidentiality of information, policies, and procedures.
Ability to set priorities and work autonomously as well as part of a team.
Sensitivity to culturally diverse people and situations.
Well-developed time-management, organization, and prioritization skills.
Knowledge of utilization management, case management, and healthcare across the health continuum.
Excellent oral and written communication skills, with a strong customer-service focus.
Ability to gather data, compile information, and prepare summary reports.
Strong interpersonal and conflict-resolution skills.
Experience in a fast-paced, multifaceted environment.
Persistence and attention to detail.
Ability to remain calm during stressful situations.
Associate degree.

Nice To Haves

At least 3 years of TCM experience.
California RN license.
BSN, CCM, and/or other insurance or workers’ compensation certifications.

Responsibilities

Establish collaborative relationships and act as an intermediary between clients, patients, employers, providers, and attorneys.
Assess, coordinate, implement, monitor, and evaluate care plans using knowledge of medical necessity, care appropriateness, and managed care principles.
Promote quality, cost-effective care throughout the health continuum and document case savings.
Document ongoing case-management activity and maintain organized files containing clinical documentation of interactions with all parties to each claim.
Assess injury severity, extent of disability, treatment plans, functional abilities, and physical job requirements to develop return-to-work plans and strategies to manage future medical exposure.